MEDNAX and ASA

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Lurch

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I see that MEDNAX is a sponsor of the ASA Practice Management Conference January 27-28th in Texas. What are everyone's thoughts on this? Have they been sponsoring ASA conferences for some time now and this is the first I am hearing of it? Do you view their inclusion as the ASA facilitating (passively or actively) the corporate takeovers by MEDNAX/American Anesthesiology and other such companies? While an ever-increasing number of anesthesiologists find themselves employed by these entities, should the ASA be taking a stand for the private practice anesthesiologists who still represent the majority and not give them a place at the table?

I know the majority of responses will be "the ASA is made up of academics who are oblivious to private practice issues or don't care about preservation of these jobs". I certainly believe this is the truth. Feel free to spout off or correct me where I'm wrong.


http://finance.yahoo.com/news/mednax-american-anesthesiology-exhibit-practice-114500360.html
 
Lurch said:
I see that MEDNAX is a sponsor of the ASA Practice Management Conference January 27-28th in Texas. What are everyone's thoughts on this? Have they been sponsoring ASA conferences for some time now and this is the first I am hearing of it? Do you view their inclusion as the ASA facilitating (passively or actively) the corporate takeovers by MEDNAX/American Anesthesiology and other such companies? While an ever-increasing number of anesthesiologists find themselves employed by these entities, should the ASA be taking a stand for the private practice anesthesiologists who still represent the majority and not give them a place at the table?
Click to expand...

Do you have any data to back up your claim that the majority (>50%) of anesthesiologists are private practice? I don't but I think that the majority of anesthesiologists are either AMC employees or employees of the hospital. Blade - can you supply us with 12 posts of data, links, and charts giving a breakdown of private practice vs. employed anesthesiologists?
 
Consigliere said:
Do you have any data to back up your claim that the majority (>50%) of anesthesiologists are private practice? I don't but I think that the majority of anesthesiologists are either AMC employees or employees of the hospital. Blade - can you supply us with 12 posts of data, links, and charts giving a breakdown of private practice vs. employed anesthesiologists?
Click to expand...

Definitely no data here. Just guessing. Maybe it's wishful thinkimg that I'm in the majority, albeit a silent one.
 
I suspect that 50-55% of Anesthesiologists are still self-employed in 2017:

For their study, AMA researchers surveyed physician practices and used 2012 American Hospital Association data to determine the percentage of physicians who remain self-employed. They found that:

  • 53% of physicians were full or part owners of a practice;
  • 42% were employees; and
  • 5% were independent contractors.
The researchers noted a significant decrease in the percentage of self-employed doctors: In 1983, 75.8% of physicians were self-employed.





AMA researchers also broke down the data by specialty and found that some were more likely to own their own practice than work for a hospital:

  • 71.9% of specialty surgeons were practice owners;
  • 68.7% of anesthesiologists were practice owners; and
  • 63.6% of radiologists were practice owners.
 
6 findings on the state of physician practice, employment in 2016
Written by Emily Rappleye (Twitter | Google+) | September 22, 2016 | " rel="nofollow" style="color: rgb(0, 57, 116); font-size: 1em;">Print | Email


88
As the physician employment trend continues, the word is out on its progress. Here is a roundup of the recent research and surveys on the state of physician practice, integration and employment.

1. Employment does not necessarily improve patient access. This survey conducted by Merritt Hawkins indicates employed physicians actually see 19 percent fewer patients than practice owners.

2. Employment may also not have an effect on the quality of care. This study suggests employment has no effect on risk-adjusted hospital-level mortality rates, 30-day readmission rates, length of stay and patient satisfaction scores for common medical conditions.

3. More physician practice owners are familiar with the Medicare Access and CHIP Reauthorization Act than employed physicians. Read more here about physicians' familiarity with the law.

4. Rapid physician practice consolidation continues, according to a study from Leavitt Partners that shows physicians in practices of 100 or more grew from 29.6 percent of physicians in 2013 to 35.1 percent in 2015.

5. Meanwhile, more hospitals are buying up physician practices. This study, conducted by Avalere Health, shows one in four practices was hospital owned by mid 2015, and that 40 percent of the nation's physicians were employed at that time.

6. The state of the industry has led nearly half of physicians to accelerate their retirement plans, according to a survey conducted by Merritt Hawkins. Read more here.
 
An overwhelming majority of physicians choose employment over private practice out of necessity, according to The Medicus Firm.The data shows in 2015 that 92.07 percent of physicians were placed as employees. Just under 8 percent of physicians were placed in private practice, according to the report. Among private practice placements, more physicians — 6.17 percent — opted for a net income guarantee, and 1.76 percent opted for gross income guarantee.

http://www.beckershospitalreview.co...s/7-key-findings-on-physician-employment.html
 
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I'm not sure about that % remaining in private practice. It could be under 50% as of today due to all the sales in 2016. A 40-45% number is probably closer to the real figure.

I think about 30% of private anesthesia groups will remain independent going forward. This 30% is a "sticky" number meaning they don't have to sell because they receive no subsidy. That said, if they get a FAT offer as the big boys run out of groups to buy all bets are off.


These buyers have maintained a high level of demand for quality anesthesia practices resulting in a competitive “seller’s market” with transaction values generally higher than we have observed in previous years.
 
The thread has turned into what group constitutes the majority of anesthesiologists and projections on that going forward. This is certainly a relevant question but not the original intent of the thread.

I take it people may not like the presence of these corporations at an ASA conference (I don't) but if they employ a significant percentage of MDs, then they deserve a place at the table? What role, if any, does the ASA have in curtailing the AMC practice model? Are they complicit in the advancement of this phenomenon of AMCs? I know the horse is out of the barn on AMCs in general but does the ASA have an obligation to preserve some semblance of the self-employed doc?
 
Lurch said:
The thread has turned into what group constitutes the majority of anesthesiologists and projections on that going forward. This is certainly a relevant question but not the original intent of the thread.

I take it people may not like the presence of these corporations at an ASA conference (I don't) but if they employ a significant percentage of MDs, then they deserve a place at the table? What role, if any, does the ASA have in curtailing the AMC practice model? Are they complicit in the advancement of this phenomenon of AMCs? I know the horse is out of the barn on AMCs in general but does the ASA have an obligation to preserve some semblance of the self-employed doc?
Click to expand...

No. The AMCs and Academic centers run the show. The AMCs have money to spread around so they can "sponsor" all sorts of conferences to get groups to look at selling their practices. It's a win-win and a good business plan.

The "private practice group" is now less than 50% and shrinking to 30% over the next few years. The good news is that AMCs are paying higher multiples so senior guys are making real bank $$$$ but the bad news is that residents will have far fewer private practices to join after their training is up.

Finally, the ASA does not care about "preserving your job" whatsoever. In fact, the AMCs are better at ponying up money for ASA membership than most groups. Hence, the AMC is a "plus" to the ASA leadership.

I still feel an obligation to contribute to our PACs. I have done well over the years and the PAC remains the BEST OPTION for residents/junior attendings to keep the AANA at bay.
 
cream.gif


It's funny that this picture popped up when I did a Google image search of Method Man.
 
Lurch said:
The thread has turned into what group constitutes the majority of anesthesiologists and projections on that going forward. This is certainly a relevant question but not the original intent of the thread.

I take it people may not like the presence of these corporations at an ASA conference (I don't) but if they employ a significant percentage of MDs, then they deserve a place at the table? What role, if any, does the ASA have in curtailing the AMC practice model? Are they complicit in the advancement of this phenomenon of AMCs? I know the horse is out of the barn on AMCs in general but does the ASA have an obligation to preserve some semblance of the self-employed doc?
Click to expand...

I've said this before, but I've gone to the ASA Practice Management Conference 3 years in a row. My first year it was amazing, the majority of talks/workshops were focused on how to strengthen your practice and how to make your group more valuable and indispensable to the hospital, etc. For residents there were workshops on contracts, negotiation, and how to investigate practice specifics to attempt to find the group that fit your desires.

By year 3, last years conference, it was 100% management group focused. Talks were no longer about strengthening your group/practice, they were about the inevitability of AMC takeovers and as such how to leverage your group to them. How to become or increase your attractiveness. Talks were given by big wigs from Team Health, etc. Most venders were AMC/locums hiring tables and much less were of the individual business solutions types that dominated only 2 years earlier.

Complete and total defeatist attitude and corporate sell out IMO. I won't be returning.
 
Oh, there's more.

Year 1 during breaks or lunch you were guaranteed to be standing around real private practice guys. Groups that were proud and looking for energetic people. A few of my resident buddies ended up interviewing with and/or signing on with groups they met at that conference. It was great for resident job opportunities/networking.

Year 3 every group that was there was either already AMC owned or actively shopping.
 
Robotic Wis-Hipple said:
Oh, there's more.

Year 1 during breaks or lunch you were guaranteed to be standing around real private practice guys. Groups that were proud and looking for energetic people. A few of my resident buddies ended up interviewing with and/or signing on with groups they met at that conference. It was great for resident job opportunities/networking.

Year 3 every group that was there was either already AMC owned or actively shopping.
Click to expand...


What you stated is the biggest problem with what has happened to practice management. People will stop attending if it continues to be a conference focused specifically on AMC issues. And if you are a resident joining an AMC my guess you have very little interest in practice management or the business side of anesthesia compared to a resident joining a PP....if I am wrong my guess is that person won't be with the AMC much longer once they figure out how they are being screwed by the AMC to pay the private equity peeps.
 
Perhaps, the AMCs would pay better and offer real 401K plans (with AMC contributions over $20K) if new grads started demanding it. I saw the same sort of thing with CRNA salaries over the years. Once people realize they are in control the AMC must pay up or go locums forever. The best thing a new grad can do is demand fair pay for fair work and that includes full retirement contributions.

1. Is the job fairly compensated for the work/call schedule?
2. Is the coverage of midlevel providers acceptable?
3. Is the retirement plan fair for physicians and not just the executives?
4. Are the acuity of the cases reflected in items 1 and/or 2?
5. Do I like the location?
 
BLADEMDA said:
Perhaps, the AMCs would pay better and offer real 401K plans (with AMC contributions over $20K) if new grads started demanding it. I saw the same sort of thing with CRNA salaries over the years. Once people realize they are in control the AMC must pay up or go locums forever. The best thing a new grad can do is demand fair pay for fair work and that includes full retirement contributions.

1. Is the job fairly compensated for the work/call schedule?
2. Is the coverage of midlevel providers acceptable?
3. Is the retirement plan fair for physicians and not just the executives?
4. Are the acuity of the cases reflected in items 1 and/or 2?
5. Do I like the location?
Click to expand...

It's all about the total dollar cost to the corporation per hour of work. I have been on the other side of this conversation. When the choice is top shelf benefits v retirement contributions v base salary, MOST new grads, both docs and CRNAs care most about base salary. Even if that is not what they should be caring about.
 
BLADEMDA said:
Perhaps, the AMCs would pay better and offer real 401K plans (with AMC contributions over $20K) if new grads started demanding it. I saw the same sort of thing with CRNA salaries over the years. Once people realize they are in control the AMC must pay up or go locums forever. The best thing a new grad can do is demand fair pay for fair work and that includes full retirement contributions.

1. Is the job fairly compensated for the work/call schedule?
2. Is the coverage of midlevel providers acceptable?
3. Is the retirement plan fair for physicians and not just the executives?
4. Are the acuity of the cases reflected in items 1 and/or 2?
5. Do I like the location?
Click to expand...

A lot easier said than done. In order to make demands, you need leverage. New grads often have no leverage when it comes to negotiating or bargaining. New grads are often not board certified yet and are not a known entity with even a few years experience. There is also usually a line of new grads waiting to fill the spot...especially in desirable areas. A new grad often doesn't have the financial leverage to walk away from a lousy offer either. With hundreds of thousands of dollars in student debt, young families, and little to no assets or savings after years of meager resident pay, a new grad doesn't have the luxury to shop around and wait a few months until they find an AMC that is willing to play ball (which is still very unlikely). Collective bargaining is really the only tool future physicians will be able to use in order to negotiate better circumstances with these large organizations. Until then, prepare to be used and abused.
 
dr doze said:
It's all about the total dollar cost to the corporation per hour of work. I have been on the other side of this conversation. When the choice is top shelf benefits v retirement contributions v base salary, MOST new grads, both docs and CRNAs care most about base salary. Even if that is not what they should be caring about.
Click to expand...

It's not just docs or nurses, most people in the country (and I'm assuming the world) value $1 of salary much more than they value $1 worth of benefits no matter what the tax consequences.
 
Mman said:
It's not just docs or nurses, most people in the country (and I'm assuming the world) value $1 of salary much more than they value $1 worth of benefits no matter what the tax consequences.
Click to expand...


But most people hardly pay any taxes.
 
Mman said:
It's not just docs or nurses, most people in the country (and I'm assuming the world) value $1 of salary much more than they value $1 worth of benefits no matter what the tax consequences.
Click to expand...

Most people are stupid. The best chance of retiring wealthy is to avoid paying taxes by funding your 401K plan to the MAX. Without this careful planning in 30 years you could be almost as broke as the day you started working.

Maxing out your retirement contributions is a good way to ensure you are building wealth for the future. Plus, it allows you to get the best bang for your buck. You end up with the potential for more earnings as your balance grows, and you also receive tax advantages.
 
To Summarize:
1) Try to max out your 401k to save on taxes and get in a super-saver mentality. The maximum contribution amount for 2017 remains $18,000 a year.

2) Once you’ve been able to max out your 401k, aim to save at least 10% of your after-tax income after maxing out your 401k in a low-cost digital wealth advisor like Wealthfront, which automatically rebalances your money for you each month based off your risk tolerance. They manage your first $15,000 in assets for free with my special invite link, and charge only 0.25% for every dollar after compared to 1% – 2% for other wealth advisors are even mutual funds. The key is to keep costs low and automatically contribute to your retirement every single month before spending money.


- See more at: http://www.financialsamurai.com/sho...r-tax-brokerage-account/#sthash.DHlqthrY.dpuf
 
nimbus said:
But most people hardly pay any taxes.
Click to expand...

There are about 120-130 million full time workers in the US and the overwhelming majority pay federal taxes in excess of any tax credits/deductions in a given year.
 
BLADEMDA said:
2) Once you’ve been able to max out your 401k, aim to save at least 10% of your after-tax income after maxing out your 401k in a low-cost digital wealth advisor like Wealthfront, which automatically rebalances your money for you each month based off your risk tolerance. They manage your first $15,000 in assets for free with my special invite link, and charge only 0.25% for every dollar after compared to 1% – 2% for other wealth advisors are even mutual funds.
Click to expand...


Did you really just try to generate referrals for your personal Wealthfront account to decrease your annual fee? I mean really? Shouldn't you at least put a disclaimer there?

If people want to invest after tax dollars, pick a broker that charges NO annual fee and has low cost trades and buy some low expense mutual funds/ETFs. It's way, way, way cheaper than Wealthfront if you are investing enough money.
 
Blade -
Thanks for all the posts, by the way. Very informative.
 
Mman said:
Did you really just try to generate referrals for your personal Wealthfront account to decrease your annual fee? I mean really? Shouldn't you at least put a disclaimer there?

If people want to invest after tax dollars, pick a broker that charges NO annual fee and has low cost trades and buy some low expense mutual funds/ETFs. It's way, way, way cheaper than Wealthfront if you are investing enough money.
Click to expand...

Whoa. I don't use Wealthfront; my brokerages are Fidelity, Vanguard and TD Ameritrade. I was posting a link to some concepts.

I have never received once cent from any referrals to any particular brokerages. I recommend low cost ETFs through Vanguard and Schwab. I recommend doing all your own research on diversification and reading 5-10 investing books. Doze can recommend them if you PM him.

For my taxable accounts I utilize tax-efficient ETFs while my non taxable accounts are primarily low cost mutual funds. I readily acknowledge that the evidence doesn't fully support higher returns for active management but I feel more comfortable with certain areas of my portfolio utilizing active management.

I am not, nor ever have been, associated with "Financial Samurai" in any way, shape or form.

Whether you choose to use Wealthfront, Betterment or go on your own I encourage research prior to choosing your broker or advisor.

https://investorjunkie.com/35919/robo-advisors/

Firms like Weathfront focus on the end-goal and is ideal for individuals who don’t care or want to learn about the details of investing. For these individuals, the 25 basis points (otherwise known as a 0.25% annual fee), or less they pay is well worth the fee, and in many cases much better than hiring a FIA — both in terms of cost and good financial advice
 
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Many of the deep-discount brokers don’t offer access to commission-free ETFs or no-transaction-fee mutual funds, which can increase costs for investors who use these funds. If that’s you, you’ll want to look at Charles Schwab and TD Ameritrade. Although both of these brokers have trade commissions that fall on the high end of the discount broker scale ($8.95 and $9.99, respectively), they also offer a large selection of ETFs and mutual funds that can be purchased with no commission or transaction costs.

TD Ameritrade has more than 100 commission-free ETFs and more than 2,000 no-transaction-fee mutual funds; Charles Schwab offers more than 200 commission-free ETFs — one of the most impressive selections available — and more than 3,000 no-transaction-fee mutual funds. Charles Schwab has a $1,000 account minimum, but it is waived on most accounts with auto-deposits of at least $100 a month.

https://www.nerdwallet.com/blog/investing/the-best-discount-brokers/
 
BLADEMDA said:
Perhaps, the AMCs would pay better and offer real 401K plans (with AMC contributions over $20K) if new grads started demanding it. I saw the same sort of thing with CRNA salaries over the years. Once people realize they are in control the AMC must pay up or go locums forever. The best thing a new grad can do is demand fair pay for fair work and that includes full retirement contributions.

1. Is the job fairly compensated for the work/call schedule?
2. Is the coverage of midlevel providers acceptable?
3. Is the retirement plan fair for physicians and not just the executives?
4. Are the acuity of the cases reflected in items 1 and/or 2?
5. Do I like the location?
Click to expand...

Even with over 50% Medicare payer mix I was pulling over 400k in salary and 52k in retirement. The AMC takeover offer was low 300s and 17k in retirement with no matching. Pathetic. There is NO excuse for the piss poor benefits offered by AMCs. Even if those working for AMCs track their hours and gross pay I bet it will be way under $200/hr. Clearly the high unit values they command do not translate to better salaries/benefits for majority of their employees.

Truth is the New Grad with 200k in debt at 6-8% can't afford to take these bad AMC deals. Do the math. You will be working till you're 70, living low middle class lifestyle, struggling to save for retirement, your kids education etc. Forget about fancy vacations and luxuries that you deserve for all that deferred gratification.

Don't rely on a corrupt ASA body like to save you. Just empower yourself and refuse to take bad deals.
 
Will AMCs actually negotiate with new grads on salary, benefits, call, etc?
 
BLADEMDA said:
No. The AMCs and Academic centers run the show. The AMCs have money to spread around so they can "sponsor" all sorts of conferences to get groups to look at selling their practices. It's a win-win and a good business plan.

The "private practice group" is now less than 50% and shrinking to 30% over the next few years. The good news is that AMCs are paying higher multiples so senior guys are making real bank $$$$ but the bad news is that residents will have far fewer private practices to join after their training is up.

Finally, the ASA does not care about "preserving your job" whatsoever. In fact, the AMCs are better at ponying up money for ASA membership than most groups. Hence, the AMC is a "plus" to the ASA leadership.

I still feel an obligation to contribute to our PACs. I have done well over the years and the PAC remains the BEST OPTION for residents/junior attendings to keep the AANA at bay.
Click to expand...

How do you know that the buyouts are higher multiples now? The last few buyouts I have heard about have not been very good deals. Certainly nothing my group would consider.
 
ERRES2288 said:
Will AMCs actually negotiate with new grads on salary, benefits, call, etc?
Click to expand...
Yes. And the negotiations will go as follows:

AMC: "Here's your contract, new grad."
New grad: "Any way we can talk about increasing the salary a bit or decreasing call?"
AMC: "No"
New grad: "But...."
AMC: "Next!"
 
drdan4 said:
Don't rely on a corrupt ASA body like to save you. Just empower yourself and refuse to take bad deals.
Click to expand...

Unfortunately the inexperienced, unprepared, scared new grad with $300k debt and a family to support cannot "refuse to take bad deals" and the AMCs are well aware of this.
 
I agree that debt/fear/lack of information is part of it but even as a new grad you can negotiate. You may get nothing but it doesn't hurt to ask the right questions. Yes an AMC can say next.... but you can say bye!
 
Scotty_G said:
I agree that debt/fear/lack of information is part of it but even as a new grad you can negotiate. You may get nothing but it doesn't hurt to ask the right questions. Yes an AMC can say next.... but you can say bye!
Click to expand...

True but you can only say that a finite number of times.
 
Consigliere said:
True but you can only say that a finite number of times.
Click to expand...

It seems that the ability to negotiate will be directly determined by the job market. I wouldn't negotiate either if I was an AMC and had a revolving door of applicants. I doubt this is the case however in undesirable areas.
 
ERRES2288 said:
It seems that the ability to negotiate will be directly determined by the job market. I wouldn't negotiate either if I was an AMC and had a revolving door of applicants. I doubt this is the case however in undesirable areas.
Click to expand...

There are certainly instances where AMCs will pony up. Few and far between but prospective applicants should try to get a sense of the regional market before accepting a suboptimal contract from one of them. In major metropolitan areas, you don't have much negotiating power. Other locales, maybe a bit.
 
ERRES2288 said:
It seems that the ability to negotiate will be directly determined by the job market. I wouldn't negotiate either if I was an AMC and had a revolving door of applicants. I doubt this is the case however in undesirable areas.
Click to expand...

correct. There is nothing special about anesthesiology that protects it from normal job market forces. If there are a line of applicants, the person offering the job doesn't have to negotiate anything.
 
Please take 5 minutes out of your day and read the comment section. These comments are probably the viewpoint of about 30-40% of those supporting the AANA. I wish that I could say only a small minority believe the comments posted on that web page; but, that would simply be false.

http://thehill.com/blogs/congress-b...ecent-rule-on-anesthesia#.WItjZI31t6g.twitter

"You and your colleagues are perpetuating a sham and calling it quality. For shame."
 
"Deciding to undergo surgery and anesthesia with a CRNA is a bit like driving with a few beers in your system. It's convenient and you're likely to get home safe, but there is a bigger risk of dying than driving sober.

If you are a patient, don't choose care with a inferiorly-trained CRNA, supervised or not.
Ask for an anesthesiologist."
 
Nurses always flood comments sections of those articles. It doesn't change the fact that the overwhelming majority of hospitals won't let them practice solo even in opt out states.
I've also never heard of someone coming in for surgery requesting CRNA only anesthesia, but have had the opposite many times.
They're loud and obnoxious, so it appears they represent more folks than they actually do.
 
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